The Secretary of the U.S. Department of Health and Human Services has provided waivers of certain federal fraud and abuse laws that may otherwise limit innovation by ACOs participating in the Next Generation ACO Model (see HHS, Notice of Amended Waivers of Certain Fraud and Abuse Laws in Connection with the Next Generation ACO Model, December 29, 2016). Pursuant to that notice, Integra Community Care Network, LLC (“Integra”) seeks waiver protection for the arrangements described below:
Integra and Care New England Health System (“CNE”), on behalf of its controlled hospitals, each of which is a Next Generation Participant in Integra, have adopted two EHR Remote Access and Services Agreements (“EHR Agreements”) that they intend to enter into with medical groups participating in the Integra Next Generation ACO that are, or have contractually committed to become, Next Generation Participants that meet certain eligibility criteria (collectively, “Medical Groups”). These EHR Agreements are substantially similar, with differences related to whether the Medical Group had previously implemented an electronic health record (“EHR”) under a prior program conducted by CNE. Under the EHR Agreements, Integra provides certain donated or discounted items and services to Medical Groups, including EHR services and support. In addition, Integra has entered into an agreement to provide funding support to Rhode Island Primary Care Physicians Corporation (“RIPCPC”), a multi-specialty independent practice association, whose participating providers are all Next Generation Participants or outside providers and suppliers that have a role in coordinating and managing care for Integra Next Generation ACO patients (“Outside Providers/Suppliers”), to fund EHR “super-user” and abstractionist positions to support the ongoing and continued maintenance, use, transmission, and receipt of EHR information among Integra’s Next Generation Participants and Outside Providers/Suppliers, and to facilitate the provision of EHR support in a more efficient and effective manner (collectively, with the EHR Agreements referred to as the “Arrangements”). The Arrangements, which were adopted by Integra on October 13, 2017, support Integra’s multi-year plan to promote information sharing of patient records by addressing the implementation and ongoing support of EHR systems. The Arrangements are designed to: (a) advance the management and coordination of care for Medicare beneficiaries through the Integra Next Generation ACO by, for example, enhancing the accuracy of patient health information, facilitating the ready exchange of patient health information among Next Generation Participants and Outside Providers/Suppliers, reducing the provision of duplicative testing, and enhancing safety by maintaining complete medication and allergy lists; and (b) encourage investment in infrastructure and redesigned care processes for high quality and efficient services delivery by allowing the Integra Next Generation ACO to make maximum use of its care management infrastructure to achieve high-quality and efficient service delivery for all patients cared for by its contracted providers.